SummaryBackgroundThe air‐Q is a new supraglottic airway device (SAD) and has been increasingly used as a primary airway device and as a conduit for tracheal intubation in children as well as in adults. This device has either performed equally or better than other SADs in children. The Ambu Aura‐i is a commonly used SAD in children undergoing various short surgical procedures. However, limited literature is available evaluating the safety and efficacy of the air‐Q and the Ambu Aura‐i in small children. We, therefore, conducted this study to compare the clinical performance of these two airway devices in infants weighing up to 10 kg. Our hypothesis is that air‐Q, due to its improved and larger cuff design will yield better airway seal pressures as compared with the Ambu Aura‐i.MethodsSixty‐four ASA I–II infants weighing <10 kg undergoing elective ophthalmic surgery were randomly assigned to receive either an air‐Q or the Ambu Aura‐i. After induction of general anesthesia (GA) and muscle relaxation, we measured oropharyngeal leak pressure (OLP) as the primary outcome. The secondary end points measured were time to insert, first insertion success rate, fiberoptic grade (FO) of laryngeal view and any other airway complications like trauma, laryngospasm, and desaturation.ResultsThe air‐Q ILA provided significantly higher OLP as compared with the Ambu Aura‐i [20.2 ± 4.6 cm H2O, CI 18.55–21.88; vs 16.2 ± 5.6 cmH2O, CI 14.27–18.25, P = 0.003; mean difference 4 ± 1.29 cm H2O, CI 1.41–6.58]. However, the Ambu Aura‐i required significantly less time for its insertion (14.6 ± 2.8 s, CI 13.66–15.70; vs 16.3 ± 1.5 s, CI 15.75–16.86, P = 0.005; mean difference 1.625 ± 0.56 s, CI 0.48–2.76). There were no differences in first insertion success rate, FO view, and postoperative complications.ConclusionWe conclude that air‐Q may be considered superior to Ambu Aura‐i in infants for controlled ventilation as it provides higher airway sealing pressures.